Surgical instrument with end effector comprising jaw mechanism and translating component, and related methods

ABSTRACT

A surgical instrument can include a shaft having a proximal end and a distal end, and a wrist coupled to the distal end of the shaft and configured to articulate in multiple degrees of freedom. An end effector having jaws may be supported by the wrist. The surgical instrument can further include a first drive element extending from the proximal end of the shaft to the end effector, the first drive element being configured to transmit forces to move the jaws relative to each other between open and closed positions, and a second drive element extending from the proximal end of the shaft to the end effector, the second drive element being configured to transmit forces to translate a component of the end effector in a longitudinal direction relative to the jaws. The component can be configured to translate independently of movement of the jaws.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. patent application Ser. No.13/399,391, filed Feb. 17, 2012 (now pending), which claims the benefitof U.S. Provisional Patent Application No. 61/444,400, filed on Feb. 18,2011, and to U.S. Provisional Patent Application No. 61/491,719, filedMay 31, 2011, the entire content of each of which is incorporated byreference herein.

TECHNICAL FIELD

Aspects of the present disclosure relate to surgical instruments thatare minimally invasive and integrate into a single device the use ofenergy to fuse tissue and a component that cuts the fused tissue. Moreparticularly, aspects of the present disclosure relate to such devicesthat have an articulating wrist mechanism that supports a surgicalinstrument end effector configured to cut and fuse tissue.

INTRODUCTION

The use of energy, such as, for example bipolar energy, to fuse tissueis known. Briefly, two or more tissues (e.g., a tissue bundle) aregripped between two electrodes, and electrosurgical energy is passedbetween the electrodes in order to fuse the tissues together. An exampleof such tissues includes the opposing walls of a blood vessel. In thisway, the blood vessel can be fused closed, resulting in a sealing of thevessel at the fused region. Surgical instruments that perform thisaction are often referred to as sealing instruments (e.g., a “vesselsealer”). Such surgical instruments also can be used, for example, forcold cutting, tissue dissection, coagulation of tissue bundles generally(e.g., other than for sealing), and tissue manipulation/retraction.

Once tissues, such as, for example, of a blood vessel, are fusedtogether, the fused region can be safely cut without any resultingbleeding. For both convenience and cutting accuracy, surgicalinstruments have been developed that utilize an end effector thatintegrates the use of tissue fusing and cutting.

The benefits of minimally invasive (e.g., laparoscopic, thoracoscopic,etc.) surgery are known. Instruments for such surgery typically have asurgical end effector mounted at the distal end of a long shaft that isinserted through an opening (e.g., body wall incision, natural orifice)to reach a surgical site. In some cases, the surgical instruments can bepassed through a cannula and an endoscope can be used to provide imagesof the surgical site. In some cases, an articulating wrist mechanism maybe mounted at the instrument's distal end to support the end effectorand change its orientation with reference to the shaft's longitudinalaxis. It can be appreciated that minimizing the outer diameter of theshaft, wrist, and end effector may be desirable to reduce patient traumaduring minimally invasive surgery.

A disadvantage of existing minimally invasive surgical instruments thatoffer an integrated tissue fusing and cutting end effector is that thearticulating wrist mechanism allows the end effector to articulaterelative to the shaft with only a single degree of freedom (DOF) (e.g.,arbitrarily defined orthogonal “pitch” or “yaw” orientations withreference to the shaft), although other DOF movements may be consideredto exist, such as, for example, roll, grip, translation (e.g., movementof cutting knife along the jaws), etc. This single articulation DOFlimitation is due to the configuration of the cutting knife, which istypically an elongated, substantially planar metal band or ribbonstructure having a distal end provided with sharp cutting edges. Such aplanar structure can flex back and forth about the plane in which thestructure lies, but not in the orthogonal plane (i.e., in the plane ofthe structure). Since the planar cutting knife structure passes throughthe wrist mechanism in order to drive the cutting knife, the wristmechanism is limited to a configuration in which only a singlearticulation DOF motion can occur, namely about the plane of the planarcutting knife; the wrist mechanism is not configured to articulatewithin the plane of the planar cutting knife structure. Cutting kniveswith planar band or ribbon structures can also impact the roll DOF of asurgical instrument, requiring various coupling structures to maintainsubstantially concentric positioning between the various elements of theend effector during roll.

Attaining sufficient gripping pressure on tissue, such as a vessel, forsealing can also be challenging in such instruments, particularly whencombined with achieving various other DOF movements, such as, forexample, roll DOF and articulation DOF. Also, attaining sufficientgripping pressure can pose challenges when attempting to reduce the sizeof the overall instrument.

Another type of minimally invasive surgical instrument is a staplinginstrument. Such stapling instruments securely staple tissues togetherwith several staple rows, and these instruments also use an integratedcutting mechanism to drive a cutting knife between the staple rows.Minimally invasive stapling instruments with a tissue cutting featurehave been developed with the integrated stapling and cutting endeffector mounted on a two-DOF articulation wrist mechanism so that theend effector orientation can be changed in both “pitch” and “yaw”. Seee.g., U.S. patent application Ser. No. 12/945,461 (filed Nov. 12, 2010;disclosing motor interface for parallel drive shafts within anindependently rotating member), U.S. patent application Ser. No.12/945,730 (filed Nov. 12, 2010; disclosing wrist articulation by linkedtension members), U.S. patent application Ser. No. 12/945,740 (filedNov. 12, 2010; disclosing double universal joint), and U.S. patentapplication Ser. No. 12/945,748 (filed Nov. 12, 2010; disclosingsurgical tool with a two degree of freedom wrist). But such instrumentswith two-DOF articulation wrist mechanisms typically have an outerdiameter of the wrist and end effector (i.e., stapler) that is largerthan many other minimally invasive surgical instruments. In oneinstance, for example, a two-DOF articulation wrist stapler has an outerdiameter of about 13 mm. In one instance, a stapling device has beenmodified to perform a tissue fusing and sealing function, and because ofits structure has an outer diameter similar to a stapling instrument.See, e.g., U.S. Patent Application Pub. No. US 2010/0292691 A1 (filedJul. 22, 2010). In contrast, other minimally invasive surgicalinstruments, such as those used with the robotic surgical systemscommercialized by Intuitive Surgical, Inc. of Sunnyvale, Calif., have anouter diameter of the wrist and/or end effector (e.g., in a closedposition of jaws of the end effector) in the range of about 8 mm orabout 5 mm.

Persons of ordinary skill in the art will appreciate that reducing theoverall size of a surgical instrument while preserving desiredfunctions, features, and capabilities is often not merely a case ofscaling down known components. Preserving design requirements for even asmall size reduction, such as reducing an instrument's outer diameter byabout 2 mm to about 3 mm, can be a difficult task due to materialproperties, component fabrication limitations, introduction of frictionbetween moving parts, limitations on strength of components as theirsizes are reduced, overall design of such smaller mechanisms whilemaintaining high force requirements, and other impacts on operation.Thus, although highly desirable, a minimally invasive surgicalinstrument with an integrated tissue fusing and cutting feature, atwo-DOF articulation wrist mechanism, and an outer diameter on the orderof other commonly used minimally invasive surgical instruments has notbeen available. In addition, such a surgical instrument that can beinterfaced with and controlled by a robotic surgical system isdesirable.

SUMMARY

The present teachings may solve one or more of the above-mentionedproblems and/or may demonstrate one or more of the above-mentioneddesirable features. Other features and/or advantages may become apparentfrom the description that follows.

In accordance with various exemplary embodiments, the present teachingscontemplate a surgical instrument that comprises a shaft having aproximal end and a distal end, and a wrist coupled to the distal end ofthe shaft and configured to articulate in multiple degrees of freedomcoupled to the distal end of the shaft. The surgical instrument canfurther comprise an end effector supported by the wrist, wherein the endeffector includes a cutting element and jaws configured to grip tissueand to fuse tissue, for example, via electrosurgical energy. Thesurgical instrument can be configured for use with a teleoperatedrobotic surgical system that can include a patient side consoleconfigured to interface with and actuate the surgical instrument and asurgeon side console configured to receive inputs from a surgeon tocontrol the actuation of the surgical instrument.

In accordance with various exemplary embodiments, the present teachingscontemplate a method of operating a surgical instrument which includesreceiving at least one first input at a transmission mechanism disposedat a proximal portion of the surgical instrument to articulate amultiple degree-of-freedom articulable wrist of the surgical instrumentin at least one of pitch and yaw, and transmitting one or more forcesvia the transmission mechanism to articulate the wrist in response tothe first input. The method further includes receiving a second input atthe transmission mechanism to open jaws of an end effector supported bythe wrist, and transmitting torque via the transmission mechanism to atorque drive component to open the jaws. The method further includesreceiving a third input at the transmission mechanism to close the jawsof the end effector, and transmitting torque via the transmissionmechanism to the torque drive component to close the jaws to grip tissuebetween the jaws. Additionally, the method includes transmittingelectrosurgical energy to the jaws to fuse the tissue, receiving afourth input at the transmission mechanism to translate a cuttingelement of the end effector, and transmitting a force to a cuttingelement drive component via the transmission mechanism to translate thecutting element relative to the end effector.

Additional objects and advantages of the present teachings will be setforth in part in the description which follows, and in part will beobvious from the description, or may be learned by practice of thepresent disclosure and/or claims. At least some of those objects andadvantages of the invention will be realized and attained by means ofthe elements and combinations particularly pointed out in the appendedclaims.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory onlyand are not restrictive of the present disclosure and claims, which areentitled to their full breadth of scope including equivalents.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure can be understood from the following detaileddescription, either alone or together with the accompanying drawings.The drawings are included to provide a further understanding of thepresent disclosure, and are incorporated in and constitute a part ofthis specification. The drawings illustrate one or more exemplaryembodiments of the present teachings and together with the descriptionserve to explain certain principles and operation. In the drawings,

FIG. 1 is a diagrammatic perspective view of a minimally invasivesurgical instrument in accordance with an exemplary embodiment of thepresent disclosure;

FIG. 2A is a partial, longitudinal cross-sectional view of a shaft andwrist of the surgical instrument of FIG. 1 in accordance with anexemplary embodiment;

FIG. 2B is a transverse, cross-sectional view of the instrument shafttaken from the perspective 2B-2B in FIG. 2A;

FIG. 3 is a detailed perspective view of the end effector, wrist, andportion of the shaft of the surgical instrument of FIG. 1 in accordancewith an exemplary embodiment;

FIG. 4 is a partially exploded, partially cut-away perspective view ofthe end effector, wrist, and portion of the shaft of FIG. 1 inaccordance with an exemplary embodiment;

FIG. 5 is a partially exploded, partially transparent perspective viewof the end effector, wrist, and portion of the shaft of FIG. 1 inaccordance with an exemplary embodiment;

FIG. 6 is a partial perspective view of a wrist drive tendon inaccordance with an exemplary embodiment;

FIG. 7A is a perspective view of a grip drive nut in accordance with anexemplary embodiment;

FIG. 7B is a cross-sectional view of the grip drive nut taken from theperspective 7B-7B in FIG. 7A;

FIG. 8A is a partial side view of an exemplary embodiment of a torquetube in accordance with an exemplary embodiment;

FIG. 8B is a cross-sectional view of the torque tube from theperspective 8B-8B of FIG. 8A;

FIG. 9 is an exploded view of a jaw assembly in accordance with anexemplary embodiment;

FIG. 10 is an isolated, partial side view of a cutting element andcutting drive component in accordance with exemplary embodiments;

FIG. 11 is a partial isolated, perspective view of the bottom jaw andcutting element of the end effector of FIGS. 3-5 in accordance with anexemplary embodiment;

FIG. 12A is a diagrammatic perspective view of an exemplary roboticsurgical system with which surgical instruments in accordance withvarious exemplary embodiments of the present disclosure can be used;

FIG. 12B is a schematic view of an exemplary robotic surgical systemwith which surgical instruments in accordance with various exemplaryembodiments of the present disclosure can be used;

FIG. 13 is a flow diagram showing an exemplary method for operating afusing and cutting surgical instrument in accordance with variousexemplary embodiments of the present disclosure;

FIGS. 14A-14B are detailed views of the corresponding labeled portionsof the surgical instrument of FIG. 1 in accordance with an exemplaryembodiment;

FIG. 15 is a cross-sectional view of an adapter structure and seals ofFIG. 2A in accordance with an exemplary embodiment;

FIG. 16 is an isolated, perspective view of jaws with spacers, shown inan open position of the jaws, in accordance with an exemplaryembodiment;

FIG. 17 is a partially cut-away perspective view of the end effector,wrist, and portion of the shaft of a fusing and cutting surgicalinstrument in accordance with an exemplary embodiment;

FIG. 18 is a perspective view of a cable routing plug in accordance withan exemplary embodiment; and

FIG. 19 is a cross-sectional view of an exemplary embodiment of achannel in the clevis of FIG. 17.

DETAILED DESCRIPTION

This description and the accompanying drawings that illustrate exemplaryembodiments should not be taken as limiting, with the claims definingthe scope of the present disclosure. Various mechanical, compositional,structural, electrical, and operational changes may be made withoutdeparting from the scope of this description and the invention asclaimed, including equivalents. In some instances, well-knownstructures, and techniques have not been shown or described in detail soas not to obscure the disclosure. Like numbers in two or more figuresrepresent the same or similar elements. Furthermore, elements and theirassociated features that are described in detail with reference to oneembodiment may, whenever practical, be included in other embodiments inwhich they are not specifically shown or described. For example, if anelement is described in detail with reference to one embodiment and isnot described with reference to a second embodiment, the element maynevertheless be claimed as included in the second embodiment.

For the purposes of this specification and appended claims, unlessotherwise indicated, all numbers expressing quantities, percentages, orproportions, and other numerical values used in the specification andclaims, are to be understood as being modified in all instances by theterm “about,” to the extent they are not already so modified.Accordingly, unless indicated to the contrary, the numerical parametersset forth in the following specification and attached claims areapproximations that may vary depending upon the desired propertiessought to be obtained by the present invention. At the very least, andnot as an attempt to limit the application of the doctrine ofequivalents to the scope of the claims, each numerical parameter shouldat least be construed in light of the number of reported significantdigits and by applying ordinary rounding techniques.

Notwithstanding that the numerical ranges and parameters setting forththe broad scope of the invention are approximations, the numericalvalues set forth in the specific examples are reported as precisely aspossible. Any numerical value, however, inherently contains certainerrors necessarily resulting from the standard deviation found in theirrespective testing measurements. Moreover, all ranges disclosed hereinare to be understood to encompass any and all subranges subsumedtherein.

It is noted that, as used in this specification and the appended claims,the singular forms “a,” “an,” and “the,” and any singular use of anyword, include plural referents unless expressly and unequivocallylimited to one referent. As used herein, the term “include” and itsgrammatical variants are intended to be non-limiting, such thatrecitation of items in a list is not to the exclusion of other likeitems that can be substituted or added to the listed items.

In accordance with various exemplary embodiments, the present disclosurecontemplates a surgical instrument that includes a shaft, a wrist thatis capable of articulating in both pitch and yaw directions andcombinations thereof, and an end effector that includes componentsoperable to perform gripping, fusing, and cutting procedures. Thepresent disclosure contemplates such a surgical instrument that is ableto provide both a sufficient gripping force (including pressure on thegripped tissue) desirable for achieving tissue (e.g., vessel) fusing anda sufficient cutting force, throughout a relatively wide range ofarticulation and roll DOF movements of the instrument. Further, invarious exemplary embodiments, the present disclosure contemplates sucha surgical instrument that is minimally invasive, and provides a compactdesign, having overall outer diameters of the shaft, wrist, and endeffector that are relatively small in comparison with other minimallyinvasive surgical instruments that use articulation wrist structures incombination with multiple purpose end effectors, such as variousstapling instruments for example.

Various exemplary embodiments of the present disclosure thus provide anintegrated tissue fusing and cutting end effector, the orientation ofwhich can be independently controlled in Cartesian pitch, yaw, and rollDOFs. In addition, the cutting element can be independently controlledin translation DOF for movement relative to the end effectorsubstantially along a longitudinal direction of the end effector jaws,even when the wrist is articulated in pitch and/or yaw relative to alongitudinal axis of the instrument shaft, and/or when the instrumentshaft and end effector are rolled (i.e., rotated about the longitudinalaxis of the shaft).

With reference now to FIG. 1, a diagrammatic view of a minimallyinvasive surgical instrument 100, and various components thereof shownin detail, in accordance with an exemplary embodiment of the presentdisclosure is depicted. FIG. 1 is a perspective view of the minimallyinvasive surgical instrument 100, and FIGS. 14A-14B show the detailedviews of an exemplary embodiment of the corresponding portion labeled inFIG. 1. The directions “proximal” and “distal” are used herein to definethe directions as shown in FIG. 1, with distal generally being in adirection further along a kinematic arm or closest to the surgical worksite in the intended operational use of the instrument 100, for example,in use for performing surgical procedures. As shown in FIG. 1, theinstrument 100 generally includes a force/torque drive transmissionmechanism 1, an instrument shaft 2 mounted to the transmission mechanism1; an integrated gripping, fusing, and cutting end effector 3 disposedat the distal end of the instrument 100; and an articulation wrist 4disposed at a distal end of the shaft 2 between the shaft 2 and the endeffector 3. In various exemplary embodiments, the overall length of theinstrument 100 from the distal end of the end effector 3 to the proximalend of the transmission mechanism 1 ranges from about 21 inches to about25 inches.

In an exemplary embodiment, the instrument 100 is configured to bemounted on and used with a minimally invasive surgical robotic system,which in an exemplary embodiment includes a patient side console 1000, asurgeon side console 2000, and an electronics/control console 3000, asillustrated in the diagrammatic perspective and schematic views of FIGS.12A and 12B. It is noted that the system components in FIGS. 12A and 12Bare not shown in any particular positioning and can be arranged asdesired, with the patient side console being disposed relative to thepatient so as to effect surgery on the patient. A non-limiting,exemplary embodiment of a surgical robotic system with which theinstrument 100 can be utilized is a da Vinci® Si (model no. IS3000)commercialized by Intuitive Surgical, Inc. In general, the surgeon sideconsole 2000 receives inputs from a surgeon by various input devices,including but not limited to, gripping mechanisms 2004, foot pedals2002, etc. The surgeon side console serves as a master controller bywhich the patient side console 1000 acts as a slave to implement thedesired motions of the surgical instrument, and accordingly perform thedesired surgical procedure. The surgeon side console 2000 also caninclude a viewer or display 2006 that allows the surgeon to view a threedimensional image of the surgical site. The patient side console 1000can include a plurality of jointed arms 1002 configured to hold varioustools, including, but not limited to, for example, a surgical instrumentwith an end effector (e.g., surgical instrument 100), and an endoscope.Based on the commands input at the surgeon side console 2000, thepatient side console 1000 can interface with a transmission mechanism ofthe surgical instrument to position and actuate the instrument toperform a desired medical procedure. The electronics/control console3000 receives and transmits various control signals to and from thepatient side console 1000 and the surgeon side console 2000, and cantransmit light and process images (e.g., from an endoscope at thepatient side console 1000) for display, such as, e.g., display 2006 atthe surgeon side console 2000 and/or on a display 3006 associated withthe electronics/control console 3000. Those having ordinary skill in theart are generally familiar with such robotically controlled surgicalsystems.

In an exemplary embodiment, the electronics/control console 3000 mayhave all control functions integrated in one or more controllers in theconsole 3000, or additional controllers (e.g., as shown at 3080 in FIG.12B) may be provided as separate units and supported (e.g., in shelves)on the electronics/control console 3000 for convenience. Suchcontrollers may, in exemplary embodiments, be in directelectrical/control communication with a surgical instrument 100, asshown, e.g., by in FIG. 12B. The latter may be useful, for example, whenretrofitting existing electronics/control consoles to control surgicalinstruments requiring additional functionality. The electronics/controlconsole 3000 also can include a separate controller 3090 forelectrocautery energy in an exemplary embodiment, which can be deliveredto the surgical instrument end effector. Likewise, although in variousexemplary embodiments, one or more input mechanisms may be integratedinto the surgeon side console 2000, various other input mechanisms(e.g., as shown by element 2090 in FIG. 12B) may be added separately andprovided so as to be accessible to the surgeon during use of the system,but not necessarily integrated into the surgeon side console 2000.

The transmission mechanism 1 transmits received actuation inputs toresulting torques and forces to effect movement of the instrument shaft2, wrist 4, and end effector 3, and associated components, to accomplishvarious motions resulting in a multi-DOF surgical instrument. Forexample, the transmission mechanism 1 can be controlled via inputs(e.g., torque inputs) to roll shaft 2, and consequently end effector 3(roll DOF); open and close jaws of the end effector 3 (grip or clampDOF); articulate wrist 4 (articulation DOF); and translate a cuttingelement (not shown in the view of FIG. 1) (translation DOF). In variousexemplary embodiments, as will be described in further detail below, thewrist 4 can be configured for two-DOF articulation in orthogonaldirections to provide both “pitch” and “yaw” movement of end effector 3(yaw being arbitrarily defined as being the plane of motion of the endeffector jaws, pitch being orthogonal to yaw).

As depicted in the exemplary embodiment of FIG. 14B, which shows theunderside of an exemplary embodiment of a transmission mechanism 141that can be used as transmission mechanism 1 in FIG. 1, the transmissionmechanism 141 can include one or more input drive disks 40 configured tointerface with a patient-side control console, such as console 1000 inFIGS. 12A and 12B, to receive input to drive the various motions of theinstrument 1, as will be explained in more detail below.

As mentioned above, in an exemplary embodiment, for example as shown inFIGS. 14A and 14B, the transmission mechanism 141 (shown in FIG. 14Awith its protective cover removed to provide an internal view) can beconfigured to receive various inputs, including for example, torqueinputs via teleoperated servo actuators of a robotic surgical systemthat interface with the input disks 40, as persons with ordinary skilledin the art are familiar with. These torque inputs can be used totransmit roll to the instrument shaft (labeled 142 in FIGS. 14A and14B), to transmit a force to open and close the jaws of the end effector(FIG. 1 shows the jaws of end effector 3 in a closed position), and totransmit a force to articulate the wrist (wrist 4 in FIG. 1), forexample, two-DOF articulation. In addition, in an exemplary embodiment,the transmission mechanism 141 can include an onboard electric motor 5that receives input voltages, for example from a robotic surgicalcontrol system (e.g., via a controller that is either integrated intocentral control console 3000 or separate therefrom but associatedtherewith), to drive the cutting element (not shown in FIG. 1) via gearsand a rack and pinion mechanism 50. For further details regardingdriving and controlling the cutting element using an onboard motor likeonboard motor 5, reference is made to U.S. Provisional PatentApplication No. 61/491,698, entitled “SURGICAL INSTRUMENT WITH MOTOR”(filed May 31, 2011), and to U.S. Provisional Patent Application No.U.S. 61/491,671, entitled “SURGICAL INSTRUMENT WITH CONTROL FOR DETECTEDFAULT CONDITION” (filed May 31, 2011), both of which are incorporated byreference in their entireties herein.

Although the exemplary embodiment of FIGS. 14A and 14B depicts atransmission mechanism 141 configured to interface and receive drivetorque/force input from a robotic surgical system that includesteleoperated servo actuators, in alternative embodiments a transmissionmechanism that relies on additional onboard motors and/or manualactuation could be utilized with the surgical instrument of FIG. 1.Persons of ordinary skill in the art will understand that depending onthe number of actuation inputs available, some instrument embodimentsmay receive all actuation inputs from outside the instrument (e.g., fromteleoperated servo motors), some (e.g., hand held instruments) may haveonboard motors to drive all the instrument features, and some, such asthe depicted embodiment of that incorporates the transmission mechanismdepicted in FIGS. 14A and 14B, may have various combinations of externalactuation inputs and onboard drive motors. In the case of onboardmotors, the input voltage used to drive such motors can be supplied froma central controller (e.g., such as electronics/control console 3000and/or associated separately mounted controllers (e.g., controller3080), as depicted in FIGS. 12A and 12B) or from voltage sourcesprovided on the instrument itself in the case of handheld instruments.Likewise, persons having ordinary skill in the art will understand thatvarious combinations of gears, pulleys, links, gimbal plates, and/orlevers, etc. (exemplary embodiments of which are depicted in FIG. 14A)can be used to transmit actuating forces and torques to variousinstrument components. For further details regarding exemplarycomponents that may be used in the transmission mechanism 1, 141 toconvert the inputs, received for example via a patient side console 1000in FIGS. 12A and 12B, to the transmission mechanism 1, 141 to torquesand/or forces to ultimately drive the motions of the shaft 2, jaws ofthe end effector 3, and wrist 4, reference is made to U.S. ProvisionalPatent Application No. U.S. 61/491,804, entitled “GRIP FORCE CONTROL INA ROBOTIC SURGICAL INSTRUMENT” (filed May 31, 2011); U.S. ProvisionalPatent Application No. U.S. 61/491,798 and U.S. patent application Ser.No. U.S. 13/297,168, both entitled “DECOUPLING INSTRUMENT SHAFT ROLL ANDEND EFFECTOR ACTUATION IN A SURGICAL INSTRUMENT” (filed May 31, 2011 andNov. 15 2011, respectively); and U.S. Provisional Application No. U.S.61/491,821, entitled “SURGICAL INSTRUMENT WITH SINGLE DRIVE INPUT FORTWO END EFFECTOR MECHANISMS” (filed May 31, 2011), all of which areincorporated by reference in their entireties herein.

The transmission mechanism 1, 141 also can accommodate electricalconductors (not shown in FIG. 1 or FIGS. 14A and 14B) to receiveelectrosurgical energy via connector 42, 142 that is ultimatelytransmitted to the end effector 3 and used to fuse tissue. Theelectrical conductors can be routed through a protective tube 43, 143from the transmission mechanism 1, 141.

With reference now to the cross-sectional views of FIGS. 2A and 2B,shaft 2 is substantially rigid and comprises a main tube 200 surroundedby an insulation layer 250. In various exemplary embodiments, the maintube 200 can be made of a material exhibiting high tensile strengthmetal with relatively thin wall thicknesses, such as, for example,stainless steel. The ability to provide a relatively strong, yet thinwalled tube permits strength requirements to be met while alsomaximizing the internal space through which various components of theinstrument can pass. In various exemplary embodiments, the outerinsulation layer can be electrically insulative and comprise a materialthat exhibits relatively high dielectric strength and relatively highscratch resistance, can be relatively easily applied to the tube 200,has relatively low friction, and/or has a relatively low dielectricconstant. In one exemplary embodiment, the outer insulation layer may bean epoxy coating, such as, for example, a multi-layer (e.g., two-layer)epoxy coating. Other suitable materials for the outer insulation layercan include, but are not limited to, for example, polyvinylidenefluoride (PVDF), polyolefin, and/or fluoroethylene-propylene (FEP).

The main tube 200 is configured for routing various components from thetransmission mechanism 1 to the wrist 4 and end effector 3 (not shown inFIGS. 2A and 2B). A center channel 210 provides a lumen that receivesboth an end effector grip hollow drive shaft 218, which is coupled to atorque drive component 18 routed through wrist 4, and an end effectorcutting element drive component 20, both of which are described in moredetail below. Disposed in the space between and concentrically with thecutting element drive component 20 and the interior surface of the driveshaft 218 is a spacer mechanism 215. The spacer mechanism 215 helps toposition the cutting element drive component 20 and to absorb forcesduring operation of the instrument that tend to buckle the cuttingelement drive component 20. In various exemplary embodiments, the spacermechanism 215 can be made of a plastic that has relatively low friction,such as, for example, low-density polyethylene (LDPE) or other suitablematerials. The hollow drive shaft 218 includes a region 218 a of largerinner and outer diameters, a region 218 c of smaller inner and outerdiameters, and a transition region 218 b where the inner and outerdiameters taper from the region 218 a to the region 218 c. Morespecifically, the region 218 a has an outer diameter that isapproximately equal to the inner diameter of the center channel 210 andan inner diameter that is sufficient to accommodate the spacer mechanism215. The region 218 c has an inner diameter that is approximately equalto the outer diameter of the cutting element drive component 20 and anouter diameter that is substantially equal to the outer diameter of thetorque drive component 18. The larger diameter region 218 a assists tominimize twisting forces on the tube 218 resulting from forcesassociated with a torque drive component 18 (explained in further detailbelow) used to open and close the jaws of the end effector. The smallerdiameter region 218 c permits the drive shaft 218 to be butt-welded tothe torque drive component 18.

The shaft 2 also includes space 211 between the center channel 210 andmain tube 200 to accommodate and route electrical conductors 11 a, 11 b(shown in FIG. 2B in cross-section) for transmitting the bipolarelectrosurgical energy to the end effector 3. In various exemplaryembodiments, an electrically insulative material 11 c, 11 d may surroundthe electrical conductors 11 a, 11 b. Tendons to control wrist 4, in amanner with which those having ordinary skill in the art are familiar,also are routed through the shaft 2 in the space 211 between the centerchannel 210 and the main tube 200. The center channel 210 assists inisolating forces from the cables 45 acting on the torque drive component18 and/or on the drive shaft 218, for example during roll DOF. In thedepicted exemplary embodiment, the tendons include cables 45 that extendpartially through and are crimped to hypotubes 245. The hypotubes 245extend from the proximal end of the shaft 2 and terminate at a locationslightly proximal to the distal end of the shaft 2. The cables 45 extendfrom the hypotube 245 approximately from an axial location along thespacer 215 and terminate at various the links of the wrist 4. Forexample, as depicted in FIG. 2A, the hypotubes 245 terminate at alocation along the shaft 2 approximately at the distal end of thetransition region 218 b of the torque drive shaft 218. Although notshown in the various views, the tendons may include cables that extendfrom the proximal ends of the hypotubes to be ultimately attached tovarious drive components in the transmission mechanism 1. The hypotubes245 assist in stiffening the tendons along most of the length of theshaft 2, where articulation is not occurring, and in absorbing tensileforces resulting from tensioning of the tendons when articulating thewrist 4. The cables 45 of the tendons, provided at the wrist 4 and atthe transmission mechanism 1, provide a compliant, flexible structurethat permits bending of the same at those locations in order toeffectively apply tension. Those having ordinary skill in the art willappreciate that structures other than cables can be used for theelements 45 of the tendons, including, for example, other filament orwire structures that can withstand relatively high tensile forces toarticulate the wrist 4 and relatively high flexibility to bend with thearticulation of the wrist 4 and at the transmission mechanism 1.

Persons of ordinary skill in the art will understand that other shaftconfigurations, including placement of various channels, tendons,electrical conductors, etc. may be used to route the various elementsthat are used to operate the end effector 3 from input at thetransmission mechanism 1 without departing from the scope of the presentdisclosure. However, in various exemplary embodiments, space limitationsin combination with required force transmission strength and maintainingconcentric operations of various components may be drivingconsiderations when determining the routing of the various structuresrequired to enable the various desired functions of the end effector.

With reference to FIG. 2A, and the isolated detailed view of FIG. 15, toconnect the distal end of the shaft 2 to the wrist 4, an adapterstructure 230 is used. The adapter structure 230 has a plug-likeconfiguration that includes a central plug portion 231 surrounded by alarger diameter head portion 232 at a distal end portion of thestructure 230. A proximal end portion 233 of the central plug portion231 has a smaller diameter and is received within the center channel210, with the outer surface of the proximal end portion 233 and theinner surface of the center channel 210 being joined by a swagedattachment. The head portion 232 connects at its distal end 232 a to aproximal link of the wrist 4 and at its proximal end 232 b to the maintube 200 of the shaft 2. The outer diameter of the head portion 232 isapproximately equal to the outer diameter of the wrist 4 and the shaft 2so as to provide a substantially smooth transition between the shaft 2and the wrist 4. In an exemplary embodiment, the adapter structure 230can be made of stainless steel.

In the exemplary embodiment shown in FIGS. 2A and 15, the adapterstructure 230 also is provided with sealing mechanisms 235, 236 (235also being shown in the view of FIG. 4). Sealing mechanism 235 providesliquid sealing for the tendons 45 and electrical conductors 11 a, 11 bat the distal end of the shaft 2. Sealing mechanism 236 provides liquidsealing for the drive shaft 218 at portion 218 c. The sealing mechanisms235, 236 can be made of various materials commonly used for seals,including, but not limited to, for example, silicone and variousthermoplastic elastomers (TPEs). In particular, sealing mechanism 236can be made of a low friction material.

With reference now to FIGS. 3-5, further details of the end effector 3and wrist 4 will now be described. FIG. 3 is a perspective view thatcorresponds to the detailed portion of FIG. 1, showing the end effector3, the wrist 4, and a portion of the shaft 2. FIG. 4 shows similarportions of the instrument as FIG. 3, but is partially exploded toprovide a better view of the upper jaw of the end effector 3 andpartially cut away at the wrist 4 and the distal end of the shaft 2 toprovide a better view of internal features of the instrument (althoughcertain internal features have been removed for ease of illustration).FIG. 5 is a similar view as FIG. 4 with an exploded view of the jaws ofthe end effector and a partially transparent and cut-away view of aclevis of the end effector 3. The tendons that operate the wrist are notshown in the view of FIGS. 4 and 5.

As shown in FIGS. 3-5, the wrist 4 includes several wrist links 12. Inthe depicted exemplary embodiment, the links 12 are arranged in apitch-yaw-yaw-pitch configuration (identified respectively with thelabels “P” and “Y” in FIG. 3), which provides two-DOF articulation ofthe wrist 4. Such a configuration is nonlimiting and exemplary, however,and other combinations of links may be provided to provide a variety ofpitch and/or yaw articulation along the wrist as desired. Moreinformation about the principles of wrist 4's general configuration canbe found, for example, in U.S. Pat. No. 6,817,974 B2, entitled “SURGICALTOOL HAVING POSITIVELY POSITIONABLE TENDON-ACTUATED MULTI-DISK WRISTJOINT,” issued Nov. 16, 2004, which is incorporated herein by reference.Wrist actuation tendons, that include cables 45, are routed throughsmall holes 46 disposed at an outer peripheral region of the wrist links12 to provide wrist movement. Constant tension on the tendons, includingcables 45 and hypotubes 245, keeps the links 12 together and the endeffector 3 properly positioned at the distal end of shaft 2.

As shown in the exemplary embodiment of FIG. 6, which shows an exemplarytendon embodiment in isolation, the cables 45 can be looped back to forma U at the distal end thereof to attach to the links 12. In theexemplary embodiment of the surgical instrument depicted, six U-shapedtendon structures as depicted in FIG. 6 can be used to control thetwo-DOF (e.g., pitch-yaw-yaw-pitch) articulation of the wrist 4, withthree U-shaped tendons terminating (i.e., looping back) at a medial linkand three U-shaped tendons terminating (i.e., looping back) at a distallink which in the exemplary embodiment includes a clevis 6 (more detailsof which are explained below), as shown in FIG. 2A. In various exemplaryembodiments, the tendons 45 are operated under a maximum working loadranging from about 5 lbs. to about 25 lbs., for example, about 16.8lbs., and are able to withstand a load of about 1.5 times to about 3times the working load.

Although in the exemplary embodiments, the tendons are U-shaped and loopback at the respective links 12 of the wrist 4, it should be appreciatedthat the cables could be provided as single cables that terminate attheir ends at the links 12 without looping back. In such aconfiguration, for example, the overall number of cables and hypotubesmay be reduced. In some cases, in such a cable configuration it may bedesirable to increase the strength of the cables from that which can beused for the U-shaped cable configuration. Those having ordinary skillin the art are familiar with various tendon configurations to operatearticulating linked wrist mechanisms in minimally invasive roboticsurgical instruments.

In various exemplary embodiments, the wrist 4 may have an outer diameterranging from about 5 mm to about 12 mm, for example, from about 5 mm toabout 8.5 mm, and an overall length L_(w) ranging from about ⅜ in. toabout ⅔ in. In various exemplary embodiments, the range of motion of thewrist 4 in either pitch or yaw, is +/−90 degrees and in roll is up toabout +/−260°, for example, +/−180 degrees. The overall size (e.g.,lateral and longitudinal dimensions) are constrained by the variousmotions (and corresponding drive mechanisms) that are transmittedthrough the wrist 4 for operation of the end effector 3, including, forexample, the translation of the cutting element and the gripping of thejaws of the end effector 3. Further, the exemplary embodiments of thepresent teachings are able to achieve these various motions of the endeffector while the wrist is articulated and rolled, for example, throughthe range of motion described above.

As discussed above, in an exemplary embodiment, the pitch and yaw inputsmay be received by the transmission mechanism 1 via teleoperated servoactuators associated with a patient side console (e.g., patient sideconsole 1000) of a robotic surgical system. For example, thetransmission mechanism 1 may be configured like the exemplary embodimentof transmission mechanism 141 and receive pitch inputs via one inputdrive disk 40 and yaw inputs via another input drive disk 40, shown inFIG. 14B, and to receive an input via another drive disk 40 to rotateinput shafts (one input shaft 60 being shown in FIG. 1B and the otherhidden from view) within the transmission mechanism 141. Through asystem of gears, links, pulleys, and a gimbal mechanism provided in thetransmission mechanism, the inputs and rotation of the input shafts 60may be transmitted, for example to increase or decrease tension in thetendons 45/245 and/or to roll the shaft 2. For various examples oftransmission mechanisms that may be used to control tension in tendonsto articulate jointed link wrist structures, reference is made to U.S.Pat. No. 6,817,974 B2, entitled “SURGICAL TOOL HAVING POSITIVELYPOSITIONABLE TENDON-ACTUATED MULTI-DISK WRIST JOINT,” issued Nov. 16,2004, which is incorporated by reference herein in its entirety.

With reference again to FIGS. 3-5A clevis 6, mentioned above, attachesthe end effector 3 to the wrist 4 and supports opposing upper and lowerjaws 7 a,7 b of the end effector 3. Jaws 7 a,7 b pivot around a clevispin 8 to move the jaws 7 a, 7 b between the open and closed positions.That is, jaw 7 a pivots about clevis pin 8 upwardly in the orientationof the surgical instrument in the figures, and jaw 7 b pivots about pin8 downwardly. (Reference is also made to FIG. 16 showing end effectorjaws 1607 a, 1607 b pivoted to an open position). The clevis pin 8extends through holes in clevis ears 9 a, 9 b and through holes 17 a, 17b provided in cam extensions 13 a, 13 b respectively associated witheach of the jaws 7 a, 7 b. The clevis ears 9 a, 9 b each include a slot10 a, 10 b (depicted in FIGS. 3 and 5). The slots 10 a,10 b each receivean oppositely extending protrusion 163 a, 163 b of a drive nut 16, asdescribed in more detail below. Each cam extension 13 a, 13 b includesan angled cam slot 14 a,14 b disposed proximal of each hole 17 a, 17 b,also for receiving the respective oppositely extending protrusions 163a, 163 b of the drive nut 16. As shown in the position of the instrumentin FIGS. 4 and 5, the cam extension 13 a provides a cam slot 14 a whichis angled downwardly in a direction from distal to proximal, while thecam extension 13 b provides a cam slot 14 b (shown in FIG. 5) that isangled upwardly in a direction from distal to proximal. As can be seenin FIG. 3, for example, the cam extensions 13 a, 13 b are configured tohave a low profile and shape so that they are substantially flush withthe outer dimensions of other portions of the surgical instrument 100,such as, for example, with the clevis 6, wrist 4, and instrument shaft2, which can facilitate removal of the instrument, for example through acannula.

To open and close the jaws 7 a, 7 b, a grip drive lead screw 15 and agrip drive nut 16 that threadingly engages with lead screw 15 can beused. FIG. 7A shows a perspective view of an exemplary embodiment of agrip drive nut 16 in isolation, and FIG. 7B shows a cross-sectional viewof the grip drive nut 16 taken from the perspective 7B-7B in FIG. 7A. Inthe depicted embodiment, grip drive nut 16 includes a metal core 161with an overmolded plastic casing 162. The overmolded plastic casing 162extends within the throughhole 164 of the grip drive nut 16 and isformed with threading that engages with the threading on the lead screw15 to reduce friction. The overmolded plastic casing 162 providesoverall structural strength to the grip drive nut 16, including to thethreading. Also, the overmolded plastic threading assists in increasingnut position precision as lead screw 15 turns. Further, the plasticcasing 162 is disposed on the top, bottom, front, and back faces of thenut 16 (in the orientations of FIGS. 3-5 and 7), and extends along theedges of the side faces of the nut 16 surrounding the metal core. Theplastic casing 162 helps to reduce friction, and thereby promoteposition precision, as the nut's 16 surfaces contact the clevis 6 andthe cam extensions 13 a, 13 b during its movement along the lead screw15. Drive nut 16 also includes two engagement pins 163 a, 163 b atopposite sides of the nut 16. Each pin 163 a, 163 b extends through anassociated cam slot 14 a,14 b and associated slot 10 a, 10 b in theclevis 6.

In an exemplary embodiment, the threading in the throughhole 164 of thegrip drive nut 16 is a multi-start threading, and has a lead of about0.1 in. per rotation. Providing a multi-start threading can facilitatemanufacturability of the nut and the lead screw, improve strength,and/or facilitate movement of the nut in two directions along the leadscrew. Also, in an exemplary embodiment, the core 161 of the nut 16 cancomprise stainless steel, for example, a stainless steel alloy, such as,for example, 17-4 stainless steel. The overmolded plastic portion 162can comprise a relatively high strength, low friction plastic capable ofbeing applied to adhere to the metal core.

The lead screw 15 is located distally against clevis pin 8 to maintainits position relative to the shaft 2 and connects at its proximal end tothe torque drive component 18. The connection to the torque drivecomponent 18 may, for example, be accomplished via a butt-weld of theproximal end of the lead screw 15 to the distal end of the torque drivecomponent 18, but such connection is non-limiting and exemplary only.Although not shown in the figures, a distal, nonthreaded end of the leadscrew 15 can be received in a counterbore hole provided in clevis pin 8disposed substantially opposite to a notch 28 in the clevis pin 8 thatreceives the cutting blade 19 of the cutting element. Accordingly, asshown in FIGS. 4 and 5, the lead screw 15 is positioned distal to thewrist 4, substantially within the clevis 6. The clevis pin 8 acts as adistal stop that prevents movement of the lead screw 15 in the distaldirection beyond the clevis pin 8. In an exemplary embodiment, aproximal stop, such as for example, a thrust ball bearing (not shown)provided in the transmission mechanism 1 can prevent the lead screw 15from moving too far in a proximal direction. In an exemplary embodiment,the thrust ball bearing may be disposed in the chassis of the motorassembly including the rack and pinion 50 shown in the exemplaryembodiment of FIG. 14A, with the hollow drive shaft 218 positionedproximate the chassis so as to absorb an axial thrust load of the hollowdrive shaft 218 and lead-screw assembly as the assembly moves in theproximal direction when the jaws 7 a, 7 b are opened. Reference is madeto U.S. Provisional Patent Application No. U.S. 61/491,698, entitled“SURGICAL INSTRUMENT WITH MOTOR” (filed May 31, 2011) and to U.S.Provisional Patent Application No. U.S. 61/491,671, entitled “SURGICALINSTRUMENT WITH CONTROL FOR DETECTED FAULT CONDITION,” (filed May 31,2011), both of which are incorporated by reference herein in theirentireties.

Thus, as the lead screw 15 rotates (via the rotational movement ofhollow drive shaft 218 and torque drive component 18, as describedfurther below), drive nut 16 travels along lead screw 15. Movement ofthe drive nut 16 along the lead screw 15 in turn moves the pins 163 a,163 b along the associated cam slots 14 a, 14 b to open and close thejaws 7 a, 7 b. That is, as drive nut 16 travels in the distal direction,jaws 7 a, 7 b pivot about the clevis pin 8 to move the jaws 7 a, 7 b tothe open position. As the drive nut 16 travels in the proximaldirection, jaws 7 a, 7 b pivot about the clevis pin 8 to move the jaws 7a, 7 b to the closed position. The location of the pins 163 a, 163 b atthe distal end of the cam slots 14 a, 14 b defines the fully openposition of the jaws 7 a, 7 b. The location of the pins 163 a, 163 bproximally in the cam slots 14 a, 14 b (i.e., approximately in theposition shown in FIG. 3, somewhat distal to the proximal ends of thecam slots 14 a, 14 b) defines the fully closed position of the jaws 7 a,7 b. Defining the fully closed position of the jaws 7 a, 7 b tocorrespond to a position of the pins 163 a, 163 b somewhat distal to theproximal ends of the cam slots 14 a, 14 b helps to ensure that the pins163 a, 163 b bearing against the cam slot surface does not stopachieving full closure of the jaws 7 a, 7 b. As mentioned above, invarious exemplary embodiments, the lead screw 15 may ultimately becoupled, e.g., through its drive mechanism, to a torque-limiting springthat acts as the mechanism by which the fully closed position of thejaws 7 a, 7 b is defined, as described, for example, in U.S. ProvisionalPatent Application No. U.S. 61/491,804 (filed May 31, 2011),”incorporated by reference in its entirety herein.

The lead screw and nut combined with the pivoting cam slots 14 a, 14 benables a strong grip force to be achieved by the jaws 7 a, 7 b, evenwithin compact space restraints and various, relatively large range ofDOF movements of the instrument. In various exemplary embodiments, thecam slots 14 a, 14 b can provide a clamped mechanical advantage of about4:1 in converting the linear motion of the nut 16 to the gripping motionof the jaws 7 a, 7 b. Persons of ordinary skill in the art willunderstand that various other jaw activation mechanisms are available,and in other embodiments only a single moving jaw may be used, with theother, opposing jaw being fixed in position. Positioning each of thepins 163 a,163 b through its associated clevis ear slot 10 a,10 b helpsprevent the drive nut 16 from twisting within the clevis 6 to provideenhanced stability of the motion of the nut and thus opening and closingof the jaws 7 a,7 b.

To transmit the torque necessary to turn lead screw 15 through wrist 4,including through a relatively large range of articulation (e.g.,orthogonal pitch and/or yaw articulation) of wrist 4 and/or roll of theinstrument, a torque drive component 18 that connects to and is drivenby drive shaft 218 is used in accordance with various exemplaryembodiments. In various exemplary embodiments, a torque drive component18 that may be used includes a multi-layered, tubular cable structure.The layered structure may have adjacent layers that comprise windings ofdiffering directions, as explained in further detail with reference tothe exemplary embodiment depicted in FIGS. 8A and 8B. Although theexemplary embodiment of FIGS. 8A and 8B include three layers ofwindings, the present disclosure is not limited to three layers. Rather,torque drive components in accordance with various exemplary embodimentscan include two or more layers of windings, for example, with each layerhaving helical turns in differing directions.

FIGS. 8A and 8B show one exemplary embodiment of a torque drivecomponent 18 that includes a tubular structure of three layers ofrelatively tightly wound windings (coils) 181, 182, 183 (shown best inthe cross-sectional view of FIG. 8B). An inner winding 181 and an outerwinding 183 each twists so as to provide helical turns traversing alongthe tube in a first direction. A middle winding 182 is disposed betweenthe inner and outer windings and twists so as to provide helical turnstraversing along the tube in a second direction opposite to the firstdirection. The first direction of twist is oriented to providecompression of the inner winding 181 and the outer windings 183 againstthemselves in the direction that moves the lead screw 15 so as to movethe jaws 7 a, 7 b to the closed position. Accordingly, as can be seen inFIGS. 4 and 5, the helical pattern of the threading on the lead screw 15and the outer winding 183 are in the opposite direction. In particular,in the exemplary embodiment depicted, the outer winding 183 has ahelical pattern of windings that rise from right to left in theclockwise direction and the threading on the lead screw 15 rises fromleft to right in the clockwise direction. The torque T_(close) (shown inFIG. 4) required to move the jaws 7 a, 7 b to the closed position toprovide a sufficient gripping force is higher than the torque T_(open)(also shown in FIG. 4) required to move the jaws 7 a, 7 b to the openposition. Accordingly, the two inner and outer windings 181, 183 areprovided to withstand this higher torque. Since torque drive component18 is a hollowed cable structure, it flexes substantially equally in alldirections, including pitch and yaw, and combinations thereof, with lowfriction. Thus, the torque drive component 18 provides a relatively lowbending force with a relatively high torque transmission capability toachieve transmission of a torque through wrist 4 sufficient to turn leadscrew 15 without significantly limiting wrist 4's articulation and rollDOFs. With regard to the latter, flexibility in all directionsfacilitates maintaining concentricity of the various elements duringroll DOF.

In one instance, the gripping pressure of the jaws 7 a, 7 b in theclosed position was sufficient to achieve vessel sealing with the wristarticulated in the range of at least about 60 degrees in variousdirections (i.e., pitch and/or yaw). In various exemplary embodiments,the tip force exerted by the jaws 7 a, 7 b when in the closed positionranges from about 4.25 lbs to about 8.75 lbs, throughout a range ofwrist articulation of at least about +/−60 degrees in various directions(i.e., pitch, yaw, or combinations thereof). Further, in variousexemplary embodiments, the jaws 7 a, 7 b are configured in the closedposition to provide a sufficiently high gripping pressure in order toeffect sealing (fusing) of the tissue (e.g., vessel). By way ofnonlimiting example, the pressure exerted by the jaws 7 a, 7 b on thetissue in the closed position ranges from about 80 psi to about 220 psi,for example from about 95 psi to about 200 psi.

In various exemplary embodiments, the inner winding 181 may have anouter diameter of about 0.045 in. and a pitch of about 0.125 Left HandLay; the middle winding 182 may have an outer diameter of about 0.059in. and a pitch of about 0.110 Right Hand Lay; and the outer winding 183may have an outer diameter of about 0.0775 in. and a pitch of about0.140 Left Hand Lay.

In another exemplary embodiment, for example, as described in moredetail below with reference to the embodiment of FIG. 17, a portion ofthe outer surface of the outer layer of the multi-layered torque drivecomponent can be removed, for example, via grinding, to provide asmoother surface, which in turn can result in increased flexibility ofthe torque drive component, greater consistency of the grip force,and/or increase the clearance between the torque drive component and thewrist.

In an exemplary embodiment, a spring, for example, provided in thetransmission mechanism 1, may be used to assist in closing the jaws 7 a,7 b, particularly to help close the jaws 7 a, 7 b when it is desirableto back the surgical instrument 100 through a cannula away from thesurgical site. Such a spring-actuated mechanism can help to preventdamage to the end effector 3 if the jaws 7 a, 7 b are not placed in theclosed position prior to retracting the instrument through a cannula.For additional details on providing a spring-actuation mechanism toassist in closing the jaws of a cutting/fusing minimally invasive,robotically controlled surgical instrument, reference is made to U.S.Provisional Patent Application No. U.S. 61/491,798 and U.S. patentapplication Ser. No. 13/297,168, both entitled “DECOUPLING INSTRUMENTSHAFT ROLL AND END EFFECTOR ACTUATION IN A SURGICAL INSTRUMENT” (filedMay 31, 2011 and Nov. 15, 2011, respectively), both of which areincorporated by reference herein in their entirety.

Those having ordinary skill in the art will appreciate that thedirection of the various windings/threading, along with the direction ofthe input torques (T_(open) and T_(close)), shown in the illustrationsof FIGS. 4, 5, 8A, and 8B can be reversed without departing from thescope of the present teachings.

With reference now to FIG. 9, in an exemplary embodiment, each jaw 7 a,7b (FIG. 9 depicts only one jaw 7 b; the other jaw 7 a is similarlyconstructed) can include a metal core part 90 b which includes the camextension 13 b, an electrode support part 91 b, and an outer cover part92 b. The electrode support part 91 b and outer cover part 92 b cancomprise a plastic material. The electrode support part 91 b insulatesthe electrode 21 b from the metal core. The outer cover part 92 breceives and supports the combined metal core part 90 b and electrodesupport part 91 b. The metal core part 90 b can provide strength to thejaws 7 a, 7 b to enable the jaws 7 a, 7 b to withstand the forcesassociated with gripping, for example, with minimal deflection. Invarious exemplary embodiments, the metal core part 90 b can comprisestainless steel or a stainless steel alloy, such as, for example, 17-4stainless steel. The electrode support part 91 b and the outer coverpart 92 b can be made by overmolding plastic around the metal core part90 b, such as, for example, a glass-filled polyphthalamide (PPA), forexample, a 10- to 30-percent glass filled PPA.

In various exemplary embodiments, the jaws 7 a, 7 b can be formed usinga multi-shot molding process. The electrode support part 91 b can beformed in a first shot of a mold and the outer cover part 92 b in asecond shot of the mold. In an exemplary embodiment, the metal core part90 b can be obtained by metal injection molding (MIM). In an alternativeembodiment, the metal core part 90 b can be machined. The electrode 21 bcan be positioned over the electrode support part 91 b, and securedthereto during the second shot molding step. Persons of ordinary skillin the art will appreciate that jaw 7 a can be formed in the same manneras jaw 7 b.

As described herein, in addition to gripping, the jaws 7 a, 7 b of theend effector 3 are configured to deliver electrosurgical energy to fusetissue together, for example, to fuse tissue of a dissected vessel inorder to seal the ends of the dissected vessel. Referring again to FIGS.4 and 5, each jaw 7 a,7 b includes an electrode 21 a, 21 b that receivesenergy from the associated electrical conductors 11 a, 11 b. In variousexemplary embodiments, each electrode 21 a, 21 b receives one pole froma bipolar energy source to create bipolar energy between the electrodessufficient to fuse tissue. In various exemplary embodiments, the voltageof the energy source may be about 220 V_(p) at a frequency ranging fromabout 100 Hz to about 400 Hz, and the power may be about 240 W to about360 W, and the temperature of the electrodes 21 a, 21 b can be about100° C. In various exemplary embodiments, the electrodes 21 a, 21 b maybe stainless steel and control algorithms for conducting the electricalenergy through the electrical conductors 11 a, 11 b can be implementedvia a teleoperated robotic surgical system, for example, using thecentral control console 3000, as depicted in the exemplary embodiment ofFIGS. 12A and 12B. In various exemplary embodiments, bipolar energysource algorithms, such as, for example, those available inelectrosurgical generator products from ErbeElektromedizin, GmbH,Germany, can be implemented (e.g., via generator 3090 in FIG. 12B) toprevent tissue sticking to the electrodes 21 a, 21 b. The electricalconductors 11 a, 11 b can be any suitable conductive wire protected withan insulation layer surrounding the wire. In one exemplary embodiment,the electrical conductors 11 a, 11 b can include a copper alloy wirewith an ethylene tetrafluoroethylene (ETFE) insulation layer.

The length, L_(e), of each of the electrodes 21 a, 21 b in variousexemplary embodiments may range, for example, from about 16 mm to about18 mm, which may be desirable for sealing a vessel having a diameter ofabout 7 mm. The width of the electrodes 21 a, 21 b, as well as thecorresponding jaws 7 a, 7 b, can present a generally tapered shape,having a larger width at the proximal end and a narrower width at thedistal end. Such a tapered shape can be beneficial for dissection oftissue, including dissection of vessels. For example, the tapered shapecan improve visibility during dissection and can provide a smallercontact area to pierce tissue. In various exemplary embodiments, thewidth at the proximal end, W_(e,p), ranges from about 2.5 mm to about5.5 mm, for example, the width may be about 5 mm; and the width,W_(e,d), at the distal end ranges from about 2.5 mm to about 3.5 mm, forexample the width may be about 3 mm. The width of the electrodes 21 a,21 b can be selected to provide fusing of both sides of dissected tissue(e.g., dissected ends of a vessel) gripped between the jaws 7 a, 7 b.For example, the width may be selected to provide at least about a 1 mmseal on either side of the dissected tissue. The thickness of eachelectrode 21 a, 21 b in various exemplary embodiments may range fromabout 0.005 in. to about 0.015 in., for example, the thickness may beabout 0.010 in. To assist in preventing tissue from sticking to theelectrodes 21 a, 21 b, the surfaces of the electrodes can be finishedwith a micro-inch surface finish, for example, an 8 micro-inch surfacefinish.

As shown, each of the electrodes 21 a, 21 b is provided with a groove 23b (corresponding groove on electrode 21 a is hidden from view in FIGS.3-5) configured to receive and provide a track for the cutting elementas it translates in the proximal and distal directions relative to thejaws 7 a, 7 b, as will be described in further detail below. In a closedposition of the jaws 7 a, 7 b, the electrodes 21 a, 21 b are maintainedspaced apart from each other to provide a gap g (see FIG. 3) by spacerlips 22 a, 22 b disposed at the distal end of each jaw 7 a, 7 b, and byspacer bars 26 a, 26 b at a proximal end of the electrodes 21 a, 21 b.The height of the spacer bars 26 a, 26 b above the surface of theelectrodes 21 a, 21 b may be slightly lower than the height of thespacer lips 22 a, 22 b above the electrode surfaces to promote a uniformgap g across the length of the electrode surfaces while also permittingthe electrode surfaces come sufficiently close along their entire lengthto ensure effective gripping and sealing of tissue.

Those having ordinary skill in the art will appreciate that otherconfigurations of spacing structures may be utilized in addition to orin lieu of either the spacer lips 22 a, 22 b and/or spacer bars 26 a, 26b. For example, spacer structures can be placed in locations along thelength of the electrode surfaces to maintain a gap between the electrodesurfaces when the jaws 7 a, 7 b are in a closed position. By way ofexample only, in one embodiment as depicted in FIG. 16, jaws 1607 a,1607 b can include spacer structures 1627 a, 1627 b on the uppersurfaces of the electrodes 1621 a, 1621 b, located, for example, in acentral portion along a length of the electrodes 1621 a, 1621 b. In anexemplary embodiment, the spacer structures 1627 a, 1627 b can be formedby providing throughholes in one or both electrodes 1621 a, 1621 b, andthen mold material underlying the respective electrodes 1621 a, 1621 bcan be permitted to flow through the throughholes and beyond theelectrode surfaces. The mold material that rises above the electrodesurfaces can form the spacer structures 1627 a, 1627 b. In this way, thespacer structures and the underlying electrode support part (e.g., likeelectrode support part 92 b in FIG. 9) are combined as a single piece.Providing spacer structures in this manner may permit relatively smallspacers to be placed along the length of the electrode using arelatively simple fabrication process. Of course those having ordinaryskill in the art will appreciate that the forming of such spacerstructures is not limited to the fabrication process described above anda variety of techniques for providing such spacer structures along theelectrode surfaces can be used. Further, although the exemplaryembodiment of FIG. 16 illustrates two spacer structures on bothelectrodes 1621 a, 1621 b, any number of such spacer structures can beprovided on one or both electrodes 1621 a, 1621 b, as desired.

In various exemplary embodiments, the gap g (shown in FIG. 3) betweenthe electrodes 21 a, 21 b when the jaws 7 a, 7 b are in the closedposition is on the order of a few thousandths of an inch, for example,about 0.004 inches.

As shown in FIGS. 4 and 5, in each jaw 7 a, 7 b, a small recess 24 a, 24b extending substantially across the width of each jaw 7 a, 7 b can beplaced distally of the associated electrode 21 a, 21 b, i.e., betweenthe electrodes 21 a, 21 b and the spacer lips 22 a, 22 b. The recesses24 a, 24 b can accommodate tissue gripped between the jaws 7 a, 7 b toassist in preventing gripped tissue from sliding out of the grip of thejaws 7 a, 7 b through the distal end of the end effector 3. The spacerlips 22 a, 22 b also can assist in preventing tissue from slidingthrough the distal end of the end effector 3. In one exemplaryembodiment, the recesses 24 a, 24 b can have a depth ranging from about0.1 mm to about 0.4 mm.

Also, in various exemplary embodiments, the upper jaw 7 a can include amarking, e.g., in the form of a line 29 extending transverse the upperjaw 7 a. The placement of the line 29 is selected so as to provide anobservable indicator to a surgeon of the extent to which the cuttingmechanism will travel along the jaws 7 a, 7 b during a cut operation. Inthis way, the surgeon can have a visible indicator that tissue capturedin the jaws 7 a, 7 b that lies between the line 29 and the garageposition of the cutting blade (described in further detail below) willbe in the path of the cutting blade during a cutting procedure. In anexemplary embodiment, the marking 29 can be made by laser-marking thejaw.

To avoid interfering with surgery or passage through a cannula, theelectrical conductors 11 a,11 b are recessed in the end effector 3 andare routed proximally back through the side channels 47 (shown in FIGS.3 and 5) in the wrist 4 and then through the shaft 2, as described abovewith reference to FIGS. 2A and 2B. The electrical conductors 11 a, 11 bultimately connect to a power generator source that may, for example, belocated at the central control console 3000 of a teleoperated roboticsurgical system depicted in FIGS. 12A and 12B. In an exemplaryembodiment, a separate one or more separate controllers 3080/3090 addedto a central control console 3000 may have a power connection to supplypower to the electrical conductors 11 a, 11 b; alternatively, the powersource may be integrated with the central control console 3000. Further,in various exemplary embodiments, to minimize interference withoperation of the end effector 3, particularly opening and closing thejaws 7 a, 7 b, the electrical conductors 11 a, 11 b can be provided withslack when they are positioned against the jaws 7 a, 7 b, as illustratedin the exemplary embodiment of FIG. 5.

As described above, in addition to gripping and fusing, the surgicalinstrument 100 can be configured to cut. As illustrated in FIG. 5, theend effector 3 thus also includes a cutting element in the form of ashort cutting blade 19 (shown also in FIGS. 10 and 11). Cutting blade 19is translated distally and proximally relative to end effector 3 by acutting element drive component 20. The cutting blade 19 travels betweena proximal-most, so-called “garaged” position and a distal-mostposition. In the proximal-most, “garaged” position, the proximal end ofthe cutting blade 19 is received in a notch 28 provided in the clevispin 8 and is protected on its sides by opposing garage features (only 27b being shown in FIGS. 4, 5, 9, and 11, and similar features beinghidden from view for jaw 7 a) that are adjacent to the opposing surfacesof the cam extensions 13 a, 13 b. The opposing garage features 27 b helpto protect tissue from entering into the proximal end of the jaws 7 a, 7b and potentially contacting the cutting blade 19. In the distal-mostposition, the distal end of the cutting blade 19 is positioned at adistal end of the grooves 23 a, 23 b respectively provided on theopposing electrode surfaces 21 a, 21 b of the jaws 7 a, 7 b. Since thecutting element drive component 20 is generally flexible, as will bedescribed, the grooves 23 a, 23 b keep the cutting blade 19 aligned asit travels along the jaws 7 a, 7 b.

With reference to FIG. 11, the position of the cutting blade 19 relativeto the bottom jaw 7 b when the cutting blade 19 is in the distal-mostposition is shown. Accordingly, throughout its translation, the cuttingblade 19 stays within the end effector 3; additionally, in its garagedposition shown in FIG. 4, the cutting blade 19 is retracted behind theelectrode surfaces 21 a, 21 b substantially within the clevis pin 8 andgarage features (27 b described above and corresponding elementassociated with jaw 7 a) of the end effector 3. Moreover, to enhancesafety of operation of the surgical instrument 100, operation (i.e.,translation) of the cutting element 19 from the garaged position can beprevented from occurring unless the jaws 7 a, 7 b are in the closedposition. In an exemplary embodiment, this can occur via a controllerand software that controls the operation to drive the cutting elementdrive component 20, as taught for example in U.S. Provisional PatentApplication No. U.S. 61/491,647, entitled “POSITIVE CONTROL OF ROBOTICSURGICAL INSTRUMENT END EFFECTOR,” (filed May 31, 2011), incorporated byreference in its entirety herein. For other control features that may beimplemented for a cutting element that is controlled and driven using arobotic surgical system (e.g., which can include use of an onboard motorlike motor 5 in FIG. 14A), reference is made to U.S. Provisional PatentApplication No. U.S. 61/491,698, entitled “SURGICAL INSTRUMENT WITHMOTOR” (filed May 31, 2011) and to U.S. Provisional Patent ApplicationNo. 61/491,671, entitled “SURGICAL INSTRUMENT WITH CONTROL FOR DETECTEDFAULT CONDITION” (filed May 31, 2011), both incorporated by referenceherein. In one exemplary embodiment, a software feature preventsactuation of the cutting blade 19, for example via control of motor 5,until the jaws 7 a,7 b are sufficiently closed to allow cutting blade 19to extend safely within slots 23 a, 23 b, without risk of the cuttingelement coming out of the slots 23 a, 23 b and potentially outside ofthe jaws 7 a, 7 b.

In the exemplary embodiments illustrated in FIGS. 5 and 10, as discussedabove, the cutting element drive component 20 is a cable having a distalend that is welded to the proximal end of the cutting blade 19. To avoidsharp edges and/or blunt surfaces where the blade 19 attaches to thecable 20, the blade 19 and cable 20 may be blend welded together toprovide a smooth interface between the two components. Providing arelatively smooth interface between the two components can reduce therisk of having the cutting element become stuck on tissue during acutting procedure. The drive component 20 is attached at a proximal endto the transmission mechanism 1, which is configured to provide a linear(push/pull) motive force to the drive component 20 and allow roll DOF,and as described above, is routed centrally through the shaft 2 andwrist 4 to the end effector 3. The cable structure of the drivecomponent 20 is sufficiently flexible so as to withstand bending invarious directions about its longitudinal axis, while also providingsufficient compressive and tensile strength to withstand and transmitthe push/pull actuation forces from the transmission mechanism 1 totranslate the cutting blade 19, including through tissue in order toeffect cutting. The central routing of the drive component 20 throughthe shaft and wrist 4 permits the surgical instrument 100 to have arelatively compact design while also providing centering of the cuttingblade 19 relative to the end effector 3 during the cutting operation.Further, central routing of the drive component 20 can reduce frictionthat acts on the drive component 20 as it moves through wrist 4,particularly when wrist 4 is articulated and/or rolled, when translatingthe cutting blade 19. In this way, the force required to drive thecutting blade 19 can be reduced in comparison with a configuration inwhich the drive component 20 is routed toward an outer periphery of theinstrument 100 as opposed to centrally. Further, central routing of thecutting drive component 20 can result in substantially no change oflength during articulation of the wrist 4, allowing the cutting blade 19to remain in the garaged position during articulation.

In an alternative embodiment (not shown), rather than a cable structure,the drive component 20 can include a superelastic flexible wire having ahigh tensile and compressive strength, such as, for example, a nitinolwire. In at least one exemplary embodiment, the cutting blade 19 alsocan be made of nitinol.

The lead screw 15 and torque drive component 18 are both hollow, andcutting element drive component 20 is routed through the hollow centersof the lead screw 15 and the torque drive component 18. Thus, theresulting combined structure of the torque drive component 18 and thecutting element drive component 20 flexes equally in pitch, yaw, andcombinations of pitch and yaw, with relatively low friction as thecombined structure passes through wrist 4. In this way the grip DOF andcutting element translation DOF can be transmitted through wrist 4 toend effector 3 in a compact configuration that allows the relativelysmall wrist 4 to operate in Cartesian pitch, yaw, and roll DOFs. As aresult, a minimally invasive surgical instrument is provided that has anend effector with integrated tissue fusing and cutting functions and awrist mechanism that allows the end effector to be oriented in Cartesianpitch, yaw, and roll (roll is enabled by changing wrist 4 pitch and yawas necessary as shaft 2 rolls).

With reference to FIG. 10, in one exemplary embodiment, the cuttingblade 19 has a concave “V” shape cutting surface 190, which can assistin pulling tissue into the cutting surface. However, such configurationis non-limiting and exemplary only, and in other configurations theblade may have a straight, angled, or curved cutting surface. As shownin FIG. 10, in an exemplary embodiment, the proximal end of the cuttingblade 19 may have rounded top corners to minimize the risk of thecutting blade 19 getting stuck when back-driven after completion of acutting procedure. In various exemplary embodiments, the blade 19 ismade of stainless steel (e.g., 716 stainless steel) and has a doublegrind cutting surface. The blade 19 can be secured to the drivecomponent 20 by various mechanisms, including, for example, welding. Invarious exemplary embodiments, the blade 19 has a height, H_(B), rangingfrom about 0.08 in. to about 0.15 in., for example about 0.10 in., and alength, L_(B), ranging from about 0.10 in. to about 0.13 in., forexample, about 0.115 in.

As mentioned above, in one exemplary embodiment, the cutting mechanismdrive component 20 can be actuated via an onboard motor disposed in thetransmission mechanism 1, for example, via an onboard motor 5 inconjunction with a worm gear and rack and pinion mechanism 50 asillustrated in the exemplary embodiment of transmission mechanism 141shown in FIG. 14A. To control the movement of the cutting blade 19, oneor more limit switches 55 (one being shown in the exemplary embodimentof FIG. 14A) can be used to sense the position of the cutting blade 19.For one exemplary embodiment of using a limit switch to sense theposition and assist in controlling the operation of the cutting blade,reference is made to U.S. Provisional Patent Application No. U.S.61/491,698, entitled “SURGICAL INSTRUMENT WITH MOTOR” (filed May 31,2011) and to U.S. Provisional Patent Application No. U.S. 61/491,671,entitled “SURGICAL INSTRUMENT WITH CONTROL FOR DETECTED FAULT CONDITION”(filed May 31, 2011), both incorporated by reference herein. Of course,those having ordinary skill in the art will appreciate that a variety ofactuation mechanisms, including but not limited to, for example, servoactuators associated with a teleoperated robotic surgical system or amanually driven actuator can be utilized to control the movement of thedrive component 20. Further, in exemplary embodiments that rely onrobotic control to actuate the cutting element drive component 20, theinstrument 100 can be provided with a feature that permits the cuttingelement 19 to be manually retracted, such as, for example, via a hexwrench or other tool configured to engage through the chassis of thetransmission mechanism, for example, with a worm gear used to drive thecutting element drive component.

As mentioned above, in various exemplary embodiments, the outer diameterof shaft 2, end effector 3 (in a closed position), and wrist 4 rangesfrom about 5 mm to about 12 mm, for example from about 5 mm to about 8.5mm, for example, the outer diameter may be about 8.5 mm in one exemplaryembodiment. Consequently, tissue fusing and cutting surgical instrumentsin accordance with various exemplary embodiments can be inserted througha patient's body wall by using a cannula capable of inserting other 5 mmor 8.5 mm class telerobotic surgical instruments. In the case of such 5mm or 8.5 mm outer diameter cutting and fusing surgical instrument, theouter diameter is about thirty-eight percent smaller than the outerdiameter of a 13 mm wristed stapling surgical instrument. Moreover, inthe case of performing cutting and fusing surgical procedures, smallerdiameters have advantages for visualization and access in suchprocedures that may be more delicate and/or difficult to perform, andgenerally within smaller spaces.

In various exemplary embodiments, the surgical instrument 100 may beconfigured as a single-use, disposable surgical instrument. Accordingly,to reduce costs associated with manufacturing the surgical instrumentyet provide an instrument sufficiently strong to perform the variousoperations required, various components are made of plastic and areformed using an injection molding process. In addition, where additionalstrength for a component is desirable, various components or partsthereof may be made using a metal injection molding (MIM) process. Byway of non-limiting example, in the transmission mechanism 1, variousgears, gimbal plates, pulleys, links, etc. may be made of plastic,machined metal, stamped sheet metal, powdered metal, and/or MIM parts.Moreover, in the case wherein an onboard motor is used as an actuator,for example, to drive the cutting element, such a motor can be arelatively inexpensive motor, such as, for example, a DC motorconfigured to deliver sufficient force when operating with voltageinputs ranging from about 5 V to about 15 V, for example, about 5.5 V toabout 10 V.

An exemplary method for using the surgical instrument 100 for performingtissue fusing and cutting will now be described with reference toexemplary steps illustrated in the flow diagram of FIG. 13. In anexemplary embodiment, as shown at 1301 in FIG. 13, the surgicalinstrument 100 can be inserted (e.g., laparoscopically orthorascopically) into the body of a patient, for example, through acannula, and advanced to a position generally in the proximity of a worksite at which a cutting and fusing procedure is desired. After insertionand advancement of the surgical instrument 100 to the desired work site,as shown at 1302, the transmission mechanism 1, 141 can receive one ormore inputs (e.g., at input disks 40 in the exemplary embodiment oftransmission mechanism 141) to roll and/or articulate the wrist 4, suchas, for example, via roll, pitch, yaw, or a combination of any of thosemotions. As explained above, the transmission mechanism 1 can transmitthe inputs into various forces and/or torques to ultimately actuate(drive) the overall instrument shaft 2 (for example via roll) and/or tomodify the tension in tendons 45 to articulate the wrist 4 in pitchand/or yaw.

Once the end effector 3 is in a desired position and orientation, at1303 in FIG. 13, the transmission mechanism 1 (e.g., at input disks 40in the exemplary embodiment of transmission mechanism 141) can receivean input to open the jaws 7 a, 7 b of the end effector 3 and theinstrument 100 can be advanced such that tissue for which fusing/cuttingis desired is positioned between the opened jaws 7 a, 7 b. As explainedabove, the transmission mechanism 1 can transmit the input to open thejaws 7 a, 7 b by exerting a torque in a first direction on the hollowdrive shaft 218 and torque drive component 18, which torque can betransmitted to rotate lead screw 15 and to move the drive nut 16 alongthe lead screw 15 toward a distal end of the end effector 3. With thetissue positioned as desired between the open jaws 7 a, 7 b, thetransmission mechanism 1 (e.g., at input disks 40 in the exemplaryembodiment of transmission mechanism 141) can receive, as shown at 1304in FIG. 13, an input to close the jaws 7 a, 7 b in order to grip thetissue. As explained above, the transmission mechanism 1 can transmitthe input to close the jaws 7 a, 7 b by exerting a torque in a seconddirection, opposite to the first direction, on the hollow drive shaft218 and torque drive component 18, which torque can be transmitted torotate lead screw 15 and to move the drive nut 16 along the lead screw15 toward a proximal end of the end effector 3.

Next, as shown at 1305 in FIG. 13, with the jaw 7 a, 7 b in a closedposition gripping the tissue, electrosurgical energy (e.g., bipolarenergy) can be passed through the electrical conductors 11 a, 11 b toactivate the electrodes 21 a, 21 b. The bipolar energy transmitted tothe electrodes 21 a, 21 b is sufficient for the electrodes 21 a, 21 b tofuse the tissue gripped between them. In an exemplary embodiment, at1306, a signal, such as for example, an audible signal (e.g., a beep orotherwise) and/or a visible signal observable for example on a monitoror other display, can be provided to the instrument operator to confirmthat the tissue fusing has been completed.

Upon completion of fusing, at 1307 in FIG. 13, an input can be providedto the transmission mechanism 1 to drive the cutting element. Asexplained above, upon receiving the input, the transmission mechanism 1can transmit various forces and torques to ultimately drive the cuttingelement drive component 20, for example, using push/pull forces on thesame. In an exemplary embodiment, the cutting element drive component 20can be actuated to drive the cutting element from the garaged position,to the distal most position, and back to the garaged position using asingle input to the transmission mechanism 1. Accordingly, the entirecutting translation motion (i.e., from the garaged position to thedistal most position and back) can be automatically completed. In anexemplary embodiment, particularly in use with a robotic surgical systemsuch as that depicted in FIGS. 12A and 12B, the cutting operation may beprevented from occurring, e.g., through the use of appropriatealgorithms and feedback sensors controlled by a controller such asintegrated with or located as a separate unit of a central controlconsole 3000, if the jaws 7 a, 7 b are not in the closed position.Reference is made to U.S. Provisional Patent Application No. U.S.61/491,647, entitled “POSITIVE CONTROL OF ROBOTIC SURGICAL INSTRUMENTEND EFFECTOR,” (filed May 31, 2011), incorporated by reference in itsentirety herein.

Once the cutting procedure has been completed, the instrument 100 can beretracted from the patient at 1308 shown in FIG. 13, for example, via acannula.

Although in various exemplary embodiments, the surgical instrument canbe operated as a hand-held device with various inputs to thetransmission mechanism being provided manually, in an exemplaryembodiment, the instrument 100 can be interfaced with a robotic surgicalsystem, such as that shown in FIGS. 12A and 12B and as described above.In such an embodiment, the transmission mechanism may be configured astransmission mechanism 141 in FIGS. 14A and 14B, and the variousdescribed inputs can be received at the input disks 40 with theinstrument disposed at a patient side console 1000 controlled via acentral control console 3000 from signals received from a surgeon sideconsole 2000. In addition, in an exemplary embodiment, to drive thecutting element, a voltage signal can be output from a controller, suchas a separate instrument control box 3080 mounted or otherwise connectedto a central control console 3000 or from a controller integratedtherewith, and received via an onboard motor 5 disposed in thetransmission mechanism 141. In various exemplary embodiments, inputsfrom the surgeon side console 2000 or from input units otherwiseaccessible to a surgeon can be provided to the controller(s) via variouspedals 2010/2090 (e.g., to control cutting and fusing), and viahand-held grasping mechanisms 2020 (e.g., to control movement of thewrist 4 and instrument shaft 2). Those having ordinary skill in the artare familiar with the general use of such teleoperated robotic surgicalsystems to provide input from a surgeon at a surgeon side console toultimately effect operation of a surgical instrument interfacing with apatient side console.

For exemplary configurations of gears, links, gimbal plates, levers,spring, rack and pinions, etc. that can be used in the transmissionmechanism, as well as control algorithms that can be implemented (e.g.,by various controllers associated with a central control console 3000)to control and transmit inputs received by the transmission mechanism 1into torques and forces used to drive the various components of the endeffector, reference is made to U.S. Provisional Patent Application No.61/491,698, entitled “SURGICAL INSTRUMENT WITH MOTOR” (filed May 31,2011); U.S. Provisional Patent Application No. U.S. 61/491,671, entitled“SURGICAL INSTRUMENT WITH CONTROL FOR DETECTED FAULT CONDITION” (filedMay 31, 2011); U.S. Provisional Patent Application No. U.S. 61/491,647,entitled “POSITIVE CONTROL OF ROBOTIC SURGICAL INSTRUMENT END EFFECTOR,”(filed May 31, 2011); U.S. Provisional Application No. U.S. 61/491,804,entitled “GRIP FORCE CONTROL IN A ROBOTIC SURGICAL INSTRUMENT,” (filedMay 31, 2011); U.S. Provisional Application No. U.S. 61/491,798 and U.S.application Ser. No. 13/297,168, both entitled “DECOUPLING INSTRUMENTSHAFT ROLL AND END EFFECTOR ACTUATION IN A SURGICAL INSTRUMENT,” (filedMay 31, 2011 and Nov. 15, 2011, respectively); and U.S. ProvisionalPatent Application No. U.S. 61/491,821, entitled “SURGICAL INSTRUMENTWITH SINGLE DRIVE INPUT FOR TWO END EFFECTOR MECHANISMS,” (filed May 31,2011), all of which are incorporated by reference in their entiretiesherein, all of which are incorporated by reference in their entirety.

FIG. 17 depicts a partially cutaway, perspective view of the wrist, endeffector and a portion of the shaft an exemplary embodiment of a fusingand cutting surgical instrument in accordance with the presentdisclosure, with various components having differing structuralconfigurations from other exemplary embodiments described above, as willbe further explained below. In the exemplary embodiment of FIG. 17, theelectrical conductors (one such electrical conductor 1711 beingdepicted), instead of having the slacked configuration as shown in FIG.5 for example, are routed in a substantially straight configurationmanner from the electrodes of the end effector. In an exemplaryembodiment, as shown, the electrical conductors 17 can be routed in asubstantially straight configuration through a molded plug 1720 (shownin isolation in FIG. 18) positioned in the clevis 1706. As shown in thedetailed view of FIG. 18, the cable routing plug 1720 in an exemplaryembodiment can be made of a molded plastic or rubber material that canroute and hold the conductor cables 1711 in a tensioned manner throughrouting holes 1722. In this way, interference of the conductor cables1711 with the movement of the surgical instrument, particularly the endeffector movement, can be minimized. In various exemplary embodiments,the cable routing plug 1720 can be made of a material selected toincrease friction between the conductor cables 1711 and the plug 1720 tothe extent some movement of the cables 1711 through the routing holes1722 occurs as a result of movement of the end effector. Exemplarymaterials that may be used for the plug 1720 include, but are notlimited to, silicone, thermoplastic elastomers, and rubbers. As above,the electrical conductors 1711 can be routed through the holes 47 asthey pass through the wrist 4, as shown in FIGS. 3 and 5.

The exemplary embodiment of FIG. 17 also illustrates a torque drivecomponent with a portion of the outer surface of the outer winding layerremoved, for example, via grinding (e.g., centerless grinding). Asillustrated in the exemplary embodiment of FIG. 17, a portion 1750 thatextends substantially along the wrist 1704 of the torque drive component1718. Such removal of a portion of the outer surface of the outer layerof the torque drive component can provide a smoother outer surface,which in turn can result in increased flexibility of the torque drivecomponent, enhance the consistency of the grip force, and/or increasethe clearance between the torque drive component 1718 and the wrist1704. In one exemplary embodiment, the outer layer of the torque drivecomponent can be ground to about half of the thickness of the winding.For example, the outer winding layer may be ground to an outer diameterof the multi-layered tubular structure ranging from about 0.068 inchesto about 0.070 inches.

As also shown in FIG. 17, in an exemplary embodiment, a relief surfaceprofile 1780 (the other relieve surface profile on the opposite side notvisible in FIG. 17) can be provided on the surfaces of the camextensions that abut the clevis ears 1709. Such a relief surface profilecan provide a clearance between the two surfaces in order to reducefriction during the opening and closing of the jaws. Another surfacethat may include a surface profile in relief is the interior surface ofthe channel in the clevis through which the torque drive componentpasses. With reference to the exemplary embodiment of FIG. 17, and thecross-sectional view of FIG. 19, the channel 1790 through which thetorque drive component 1718 passes in the clevis 1706 can be providedwith a relief interior surface profile 1795 to assist in reducingfriction between the torque drive component 1718 and the channel 1790.

Those having ordinary skill in the art will appreciate that the variouscomponent configurations described above with reference to FIG. 17-19can be included in combination with any of the other exemplaryembodiments described herein, including operational aspects.

Further modifications and alternative embodiments will be apparent tothose of ordinary skill in the art in view of the disclosure herein. Forexample, the systems and the methods may include additional componentsor steps that were omitted from the diagrams and description for clarityof operation. Accordingly, this description is to be construed asillustrative only and is for the purpose of teaching those skilled inthe art the general manner of carrying out the present teachings. It isto be understood that the various embodiments shown and described hereinare to be taken as exemplary. Elements and materials, and arrangementsof those elements and materials, may be substituted for thoseillustrated and described herein, parts and processes may be reversed,and certain features of the present teachings may be utilizedindependently, all as would be apparent to one skilled in the art afterhaving the benefit of the description herein. Changes may be made in theelements described herein without departing from the spirit and scope ofthe present teachings and following claims.

It is to be understood that the particular examples and embodiments setforth herein are nonlimiting, and modifications to structure,dimensions, materials, and methodologies may be made without departingfrom the scope of the present teachings. For example, various aspectshave been described in the context of an instrument used in a surgicalrobotic system. But these aspects may be incorporated into hand-heldinstruments as well, with powered or hand-actuated actuation of thevarious degrees of freedom (e.g., shaft roll, wrist pitch and yaw, grip,knife).

Other embodiments in accordance with the present disclosure will beapparent to those skilled in the art from consideration of thespecification and practice of the invention disclosed herein. It isintended that the specification and examples be considered as exemplaryonly, with a true scope and spirit being indicated by the followingclaims.

What is claimed is:
 1. A surgical instrument comprising: a shaft havinga proximal end and a distal end, a longitudinal axis being definedbetween the proximal and distal ends; a wrist having a proximal end anda distal end, the proximal end of the wrist being coupled to the distalend of the shaft, the wrist being movable in pitch and yaw degrees offreedom, wherein the pitch degree of freedom is defined orthogonal tothe longitudinal axis, and wherein the yaw degree of freedom is definedorthogonal to the longitudinal axis and to the pitch degree of freedom;a surgical end effector coupled to the wrist, the surgical end effectorcomprising a jaw mechanism and a translating component, the translatingcomponent being movable lengthwise relative to the jaw mechanism; a jawmechanism drive element extending through the wrist and coupled to thejaw mechanism; and a translating component drive element extendingthrough the wrist and coupled to the translating component of thesurgical end effector, the translating component being configured tomove lengthwise relative to the jaw mechanism in response to thetranslating component drive element translating along the longitudinalaxis.
 2. The surgical instrument of claim 1, further comprising: a leadscrew configured to rotate in response to force transmitted by the jawmechanism drive element; and a drive nut configured to move along thelead screw in response to rotation of the lead screw, wherein movementof the drive nut along the lead screw moves the jaw mechanism betweenopen and closed positions.
 3. The surgical instrument of claim 2,wherein the jaw mechanism comprises a first jaw member and a second jawmember opposing the first jaw member, the first jaw member comprising acam extension having a cam slot that receives a portion of the drivenut.
 4. The surgical instrument of claim 1, the jaw mechanism beingconfigured to move between open and closed positions in response torotation of the jaw mechanism drive element.
 5. The surgical instrumentof claim 4, wherein the jaw mechanism drive component comprises a torquetube having multiple concentric winding layers.
 6. The surgicalinstrument of claim 5, wherein the multiple concentric winding layerscomprise at least two winding layers, the at least two winding layershaving opposite winding directions.
 7. The surgical instrument of claim5, wherein the multiple concentric winding layers comprise an innerwinding layer, an outer winding layer, and a middle winding layerbetween the inner winding layer and the outer winding layer each of theinner and outer winding layers having a first winding direction, and themiddle winding layer having a second winding direction opposite to thefirst direction.
 8. The surgical instrument of claim 5, wherein the jawmechanism drive component comprises a lead screw and a drive nutconfigured to move along the lead screw in response to rotation of thelead screw, wherein the torque tube extends through the wrist and has adistal end coupled to the lead screw, and wherein the drive nut isengaged with the jaw mechanism to open and close the jaw mechanism inresponse to movement of the drive nut along the lead screw.
 9. Thesurgical instrument of claim 1, further comprising a transmissionmechanism at a proximal portion of the surgical instrument, thetransmission mechanism being configured to receive one or more inputsand, in response to receiving the one or more inputs, transmit force totranslate the translating component drive element and transmit torque torotate the jaw mechanism drive element.
 10. The surgical instrument ofclaim 1, wherein the translating component drive element is flexible inthe pitch and yaw degrees of freedom at least at the wrist.
 11. Thesurgical instrument of claim 10, wherein the translating component driveelement comprises a cable.
 12. The surgical instrument of claim 1,wherein the translating component drive element extends through a centerlumen of the shaft and the wrist from the proximal end of the shaft tothe end effector.
 13. The surgical instrument of claim 1, wherein thejaw mechanism comprises an electrode configured to deliver energysufficient to fuse tissue.
 14. The surgical instrument of claim 13,wherein the jaw mechanism is configured to grip tissue in a closedposition with a sufficient pressure to permit fusing of the tissueduring delivery of the energy in the closed position.
 15. The surgicalinstrument of claim 1, wherein the translating component drive elementincludes a wire.
 16. The surgical instrument of claim 1, wherein thetranslating component comprises a blade.
 17. The surgical instrument ofclaim 1, wherein the jaw mechanism drive element comprises a torquetube, and the translating component drive element comprises a cableextending through the torque tube.
 18. The surgical instrument of claim1, wherein the surgical instrument is configured to interface with apatient side cart of a teleoperated surgical system.
 19. The surgicalinstrument of claim 1, wherein the jaw mechanism is configured to exerta grip force ranging from about 4.25 lbs to about 8.75 lbs throughout arange of wrist articulation of +/−60 degrees in each of the pitch andyaw degrees of freedom.
 20. The method of claim 1, further comprising atransmission mechanism at a proximal portion of the surgical instrument,the transmission mechanism being configured to transmit force along theshaft to move the wrist in at least one of the pitch and yaw degrees offreedom.
 21. A method of operating a surgical instrument, the methodcomprising: transmitting a first force from a transmission mechanismdisposed at a proximal portion of a shaft of the surgical instrument toarticulate a wrist of the surgical instrument coupled to a distal end ofthe shaft, the wrist being articulatable in pitch and yaw degrees offreedom, wherein the pitch degree of freedom is defined orthogonal to alongitudinal axis of the shaft, and wherein the yaw degree of freedom isdefined orthogonal to the longitudinal axis and to the pitch degreefreedom; transmitting a second force from the transmission mechanism toa jaw mechanism drive element coupled to move a jaw mechanism of an endeffector supported by the wrist, the jaw mechanism closing in responseto the second force; and transmitting a third force from thetransmission mechanism to a translating component drive element coupledto a translating component of the end effector, the translatingcomponent moving lengthwise relative to the jaw mechanism in response tothe third force.
 22. The method of claim 21, wherein transmitting thesecond force comprises transmitting a torque to the jaw mechanism driveelement to rotate the jaw mechanism drive element.
 23. The method ofclaim 21, wherein transmitting the third force comprises transmitting apush force or a pull force to the translating component drive element.24. The method of claim 21, wherein the jaw mechanism extends in adistal direction away from a distal end of the wrist, and wherein movingthe translating component comprises moving the translating componentbetween relatively proximal and distal positions along the jawmechanism.
 25. The method of claim 21, wherein the jaw mechanismcomprises a first jaw and a second jaw opposing the first jaw, andwherein moving the translating component comprises moving thetranslating component between the first and second jaws.
 26. The methodof claim 21, further comprising conducting electrical energy betweenjaws of the jaw mechanism in the closed position of the jaw mechanism,the electrical energy being sufficient to fuse tissue gripped by the jawmechanism in the closed position.
 27. The method of claim 21, whereinthe translating component drive element extends through the wrist of thesurgical instrument.